Ulcerative Colitis

[Tbird]

ulcerative colitis diagnosed - any advice on managing this from some who has it? it seems the statistics aren't so good for needing an operation 25 - 40 percent need the surgery according to what i read.

has anyone been service connected for this and how?

[Soliz]

On 5/10/2009 at 5:24 AM, Tbird said:

ulcerative colitis diagnosed - any advice on managing this from some who has it? it seems the statistics aren't so good for needing an operation 25 - 40 percent need the surgery according to what i read.

 

has anyone been service connected for this and how?

Third - I know this is old, but it popped up when researching ulcerative colitis.  I am trying to get mine service connected.  You ever have any luck?

[jbasser]

http://en.wikipedia.org/wiki/Ulcerative_colitis

I dont have it but it may be considered a genetic issue, according to the source above.

I did read the surgury was to remove a large portion of the bowell.

it is also treated like an autoimmune disease. ( The Body attacks itself) .

Follow the Doctors orders closely.

J

[Wings]

x

x

x

http://edocket.access.gpo.gov/cfr_2004/julqtr/38cfr4.114.htm

7323 Colitis, ulcerative:

Pronounced; resulting in marked malnutrition, anemia, and general debility, or with serious complication as liver abscess ................ 100

Severe; with numerous attacks a year and malnutrition, the health only fair during remissions ................. 60

Moderately severe; with frequent exacerbations .............. 30

Moderate; with infrequent exacerbations ................. 10

SEARCH BVA (Example):

http://www.va.gov/vetapp08/files4/0830558.txt

Entitlement to service connection for a gastrointestinal

disorder, claimed as ulcerative colitis, to include as

secondary to service-connected PTSD.

In the present case, the veteran has submitted evidence

indicating that his service-connected PTSD (evaluated as 100

percent disabling) may aggravate his ulcerative colitis. In

July 2008, the veteran's representative submitted a printout

from MedicineNet.com indicating that psychological stress can

increase the symptoms of ulcerative colitis. Several VA Axis

I diagnoses of PTSD are accompanied by Axis III diagnoses of

history of ulcerative colitis or history of irritable bowel

syndrome. VA outpatient clinical records dated in January

2004 and October 2004 relate that the veteran was informed

that the medication prescribed for his PTSD could result in

gastrointestinal symptoms such as constipation, nausea and

diarrhea.

In light of the foregoing, a VA examination is warranted to

determine the relationship between the veteran's service-

connected PTSD and the severity of his claimed

gastrointestinal disorder.

[david walker]

I was recently diagnosed with Pan colitis. This ulcerative colitis in both the small and large intestine. When I went to the VA with my syptoms my VA doc didn't even check my colon. Said it was just nerve pain in my back causing my stomach to hurt, and put me on nose spray stating my eyes were so puffy because of allergies :{ My second doctor (a surgeon stated it was not genetic) he first thought bacterial, turned out it was not. So, he sent me to a specialist. I go back in 3 months. He is treating with medicine. Which has helped but not cured, there is no cure. Watching what you eat, or not eating helps. The specialist said I would need a colonscopy every three years till I hit the 8 year mark, then every year, cause that is when it is most likely to turn to cancer. I know my meds have had and effect on this and more than likey caused this. What I don't know is how to connect the two. When someone is own medication that caused chronic constipation you know its gonna make your colon sick :{

[Wings]

UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

No. 06-2871

Hufford W. Rife, Appellant,

v.

James M. Peake M.D.,

Secretary of Veterans Affairs, Appellee.

Before SCHOELEN, Judge.

MEMORANDUM DECISION

Note: Pursuant to U.S. Vet. App. R. 30(a),

this action may not be cited as precedent.

SCHOELEN, Judge: Mr. Hufford W. Rife, through counsel, seeks review of an August 1, 2006, decision of the Board of Veterans' Appeals (Board or BVA) that denied service connection for a gastrointestinal disorder, post-traumatic stress disorder (PTSD), and pelvic pain. The Board also declined to grant increased disability ratings for service-connected major depression, scarring of the penis, and prostatitis. Record (R.) at 1-46. Both parties have filed briefs. Because the appellant has not presented any arguments regarding service connection for PTSD and a rating increase for scarring of the penis and prostatitis, these claims are deemed abandoned. See Ford v. Gober, 10 Vet.App. 531, 535 (1997); see also Grivois v. Brown, 6 Vet.App. 136, 138 (1994) (issues or claims not argued on appeal are considered abandoned). This appeal is timely, and the Court has jurisdiction to review the Board decision pursuant to 38 U.S.C. §§ 7252(a) and 7266(a). Singlejudge disposition is appropriate when, as here, the issue is of relative simplicity and the outcome is not reasonably debatable. See Frankel v. Derwinski, 1 Vet.App. 23, 25-26 (1990). For the reasons that follow, the Court will vacate in part and affirm in part the August 1, 2006, Board decision.

I. SERVICE CONNECTION FOR GASTROINTESTINAL DISORDER

The appellant had active duty in the U.S. Army between January 1951 and January 1953. In October 1951, he was treated for complaints of a poor appetite and constipation. R. at 5859. The appellant reported no complaints of a stomach disorder during his January 1953 separation medical examination. A clinical examination of his gastrointestinal system was within normal limits. R. at 91-93. In 1971, during a VA medical examination, the appellant complained that he experienced pain in his stomach a few minutes after meals. R. at 126-32. After a physical examination, his gastrointestinal system was noted to be normal. Id.

In February 1997, the appellant was hospitalized because of complaints of, inter alia, abdominal pain and diarrhea. R. at 1465. The entrance diagnosis was chronic diarrhea and possible colitis. Id. During his hospitalization, the appellant underwent a colonoscopy# that showed evidence throughout the colon of mucosal ulceration, necrosis, acute inflammation and pseudo tumor formations. R. at 1467. The biopsy report states that the test results were consistent with "ischemic colitis"# but noted that "ulcerative colitis could not be ruled out."# Id. Tissue samples were submitted to an outside laboratory "for further evaluation and [a] second opinion." Id.

The discharge diagnosis was "chronic diarrhea with positive stool occult blood, most likely from ulcerative colitis" and a history of gastroesophageal reflux disease. R. at 1465 (emphasis added). However the discharge record also stated that the diagnosis was made without the benefit of the results from the outside laboratory, which it had not yet received. R. at 1468. In March 1997, the outside laboratory completed its review and concluded that the biopsy showed an "injury pattern suggestive of ischemic enterocolitis" and not the changes that were associated with ulcerative colitis R. at 1770.

In an April 9, 1997, statement, Dr. Southerland, one of the appellant's treating physicians, noted that the appellant suffered from colitis that "seems to occur more frequently due to stress." R. at 1474. In May 1997, the appellant filed a claim for service connection for colitis. R. at 1504, 1694. He alleged that his colitis was caused by antibiotics that he taken over a long period to treat his serviceconnected prostatitis. R. at 1694. He also claimed that his mental condition either caused or aggravated his colitis. Id.

In support of his claim, the appellant submitted excerpts from several medical articles regarding colitis. The articles explained that there are different types of colitis, including ulcerative colitis, and pseudomembranous or antibiotic colitis.# R. at 1472-73, 1507, 1578, 1762, 1773. They state that colitis may be caused by a viral or bacterial infection, an allergic reaction or immune problem, some food, medicines or alcohol. R. at 1472-73, 1575. They also revealed that stress may cause colitis or it may contribute to the severity of the attack. R. at 1473, 1575. The articles also stated that ulcerative colitis is a common form of colitis and that the etiology of this disease is unknown. R. at 1472. The appellant also submitted excerpts from medical treatises that stated that anxiety and depression can exacerbate gastrointestinal illnesses. R. at 2752-53.

In October 1997, the appellant underwent a colonoscopy after which he was diagnosed with "mild nonspecific colitis." R. at 2020-21. In November 1997, he filed a claim for service connection for "indigestion," which he stated began during service. R. at 1700. Several weeks later, in December 1997, the appellant was hospitalized with complaints of bloody diarrhea. R. at 2114-18. The hospital entrance report noted that the appellant had a "history of questionable ulcerative colitis or Crohn's disease."# R. at 2115. A small-bowel x-ray report showed abnormalities that were considered "compatible with quiescent or indolent inflammatory disease" such as Crohn's disease. R. at 2118. The final discharge diagnosis was "possible Crohn's disease in the jejunum."# Id.

In December 1997, a private physician noted that the appellant was reluctant to take antibiotics for his lung condition because of his concern that previous antibiotic treatment for his prostatitis had caused his colitis. R. at 1474. The physician commented that "t is a real possibility" that the antibiotics given to treat the appellant's lung and prostrate problems had "caused some of the colitis [sic] he now has." Id. The physician diagnosed the appellant with colitis secondary to multiple antibiotic use. R. at 1790. In an undated VA medical report, received by a VA regional office (RO) in 1998, the appellant was diagnosed as having colitis secondary to antibiotic use. R. at 2032. The physician stated that if the appellant had to have antibiotics to treat any condition, they should be administered by injection. Id.

In December 1997, the RO denied the appellant's service-connection claim for a gastrointestinal disorder. R. at 169798. The appellant appealed this decision to the Board. R. at 1713, 1746-59, 1805-06. In October 1998, the Board remanded the appellant's claim for additional development including a gastrointestinal medical examination to determine "the nature and etiology of a gastrointestinal disorder." R. at 1913. As part of the remand proceedings, in May 2005 the appellant underwent a VA gastrointestinal medical examination. R. at 2737-38. The VA examiner found that the appellant's medical records, beginning in 1997, reveal that he had ulcerative colitis, which was currently inactive. The VA examiner stated: "The fact is that this patient does not have antibiotic-induced colitis. He has by definition and by history ulcerative colitis. Ulcerative colitis is not caused by antibiotic use. I do not in any way consider that it will be possible for him to have ulcerative colitis not at this date, and being secondary to antibiotics that were given in the past." R. at 2737-38.

The VA examiner also diagnosed the appellant as having gastroesophageal reflux disease. R. at 2737. With regard to both of the appellant's gastrointestinal problems, the examiner concluded that "in no way can either of these conditions be linked to any incident in service nor were they caused or aggravated by another serviceconnected prostatits or treatment for prostatitis." R. at 2738.

On August 1, 2006, the Board issued the decision here on appeal. R. at 1-46. Regarding the appellant's gastrointestinal claim, the Board concluded that "[t]he competent medical evidence shows the veteran does not have a gastrointestinal disorder that began during or is linked to service, nor does it show that he has a gastrointestinal disorder that was caused or aggravated by his serviceconnected prostatitis, to include treatment for same." R. at 7.

The appellant argues that the Board's finding that his colitis was not caused or aggravated by his service-connected prostatitis is clearly erroneous, and he urges the Court to reverse the Board's finding. Appellant's Brief (Br.) at 8-10. He argues further that the Board erred when it concluded that the preponderance of the evidence was against the claim. Id. He contends that the Board erred in rejecting the favorable December 1997 and June 1998 medical reports diagnosing colitis secondary to antibiotics. He states that these reports were especially probative because they were supported by the objective medical evidence, specifically, the colonoscopies that the appellant underwent between February 1997 and December 1997. Id.

The Secretary counters that the Board weighed the favorable medical evidence against the unfavorable May 2005 VA medical examiner's opinion and concluded that the VA's May 2005 medical opinion was more probative. Secretary's Br. at 13. The Secretary argues further that December 1997 and June 1998 medical opinions are the only medical evidence favorable to the appellant's claim; all other evidence weighs against the claim that his colitis was antibiotic-induced. Secretary's Br. at 12.

The medical evidence in this case consists of opinion evidence and objective medical evidence. The Court agrees with the Secretary that the objective medical evidence does not show that the appellant suffers from antibiotic-induced colitis. To the contrary, the colonoscopies indicate that the appellant had either ischemic colitis, nonspecific colitis, or Crohn's disease. The flaw in the appellant's argument appears to be his belief that a diagnosis of ischemic colitis, nonspecific colitis, or Crohn's disease is synonymous with a diagnosis of antibioticinduced colitis. In his brief, the appellant states that the February 1997 colonoscopy concluding that the appellant had ischemic colitis "conclusively establishes that [the] Appellant suffers from antibiotic-induced colitis, not ulcerative colitis." Appellant's Br. at 10 (emphasis added). However, there is no evidence in the record that supports his contention. Indeed, the medical articles that he submitted to support his claim indicate that the various types of colitis are distinct from each other and that a diagnosis of ischemic colitis, nonspecific colitis, or Crohn's disease are not the equivalent of a diagnosis of antibiotic-induced colitis.

Although the Court agrees with the Secretary that the appellant is incorrect in stating that the objective medical evidence supports his claim, the Court holds that the Board did not provide an adequate statement of reasons and bases for its implicit rejection of the favorable 1997 and 1998 medical opinions that diagnosed the appellant as having antibiotic-induced colitis. It is well established that the Board must base its decision on "all evidence and material of record" and must provide "a written statement of the Board's findings and conclusions, and the reasons or bases for those findings and conclusions, on all material issues of fact and law presented on the record." 38 U.S.C. § 7104(d)(1); see also Pond v. West, 12 Vet.App. 341 (1999); Gilbert, 1 Vet.App. 49, 5657 (1990). To comply with this requirement, the Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet.App. 36, 39-40 (1994); Gilbert, supra. Although the Board is not required to accept the medical authority supporting a claim, it must provide its reasons for rejecting such evidence. Smith (George) v. Brown, 8 Vet.App. 546, 553 (1996) (en banc).

Here the Board, without explanation, stated that "there is no competent evidence from a professional connecting the current gastrointestinal disorder to the veteran's active service or to any of his serviceconnected disabilities." R. at 16. The Board did not explain why it concluded that the favorable 1997 and 1998 medical opinions did not constitute competent medical evidence. Morever, the Board did not explain the probative value of this evidence or provide reasons for its rejection of these favorable medical opinions. The Board's failure to provide an adequate statement of reasons or bases for its decision frustrates effective judicial review. Allday v. Brown, 7 Vet.App. 517, 527 (1995).

The appellant next argues that the Board erred in relying upon the May 2005 VA medical opinion. Essentially, he contends that this opinion was inadequate because it was "speculative" and contradicted by the objective medical evidence. Appellant's Br. at 9. A medical opinion is adequate when it is based upon consideration of the appellant's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of claimed disability will be a fully informed one. Ardison v. Brown, 6 Vet.App. 405, 407 (1994); Green v. Derwinski, 1 Vet.App. 121, 123 (1991). On the other hand, a medical opinion based on an inaccurate factual premise is of no probative value. Reonal v. Brown, 5 Vet.App. 458, 461 (1993).

The Court agrees with the appellant that the May 2005 VA examination was inadequate because it was not based on an accurate account of the appellant's prior medical history. The May 2005 examiner stated that the appellant had ulcerative colitis and concluded from this fact, that the appellant's colitis could not have been caused by antibiotics. R. at 2738. He explained that he based his opinion on the appellant's 1997 medical records, which he opined, conclusively established that the appellant has ulcerative colitis. Id.

However, a review of the 1997 medical records discloses that the appellant was not diagnosed as having ulcerative colitis. In February 1997, the appellant was diagnosed with "chronic diarrhea with positive stool occult blood, most likely from ulcerative colitis." R. at 1475 (emphasis added). The hospital discharge record makes clear that this was a provisional diagnosis because the hospital had not yet received a colonoscopy report from an outside laboratory. The outside laboratory was asked to provide a second opinion because the colonoscopy performed by the hospital was inconclusive, as it indicated that the appellant had ischemic colitis but could not rule out the possibility of ulcerative colitis. R. at 1496. In March 1997, the outside laboratory completed its review and concluded that the biopsy showed "an injury pattern suggestive of ischemic enterocolitis," and not ulcerative colitis. R. at 1770.

In October 1997, another colonoscopy showed that the appellant had "nonspecifc colitis" (R. at 2021), and in December 1997, the appellant's hospital discharge diagnosis was "possible Crohn's disease" (R. at 2118). Thus, contrary to the VA examiner's 2005 report, the 1997 hospital records contained several different assessments regarding the type of colitis that the appellant had, but ulcerative colitis appears to have been considered and ruled out. At the very least, the multiple diagnoses in the 1997 medical records raise a significant question as to what form of colitis the appellant had.

Because the VA examiner's 2005 opinion is based on an inaccurate factual premise concerning the appellant's medical history, his opinion is of "questionable probative value." See Mariano v. Principi, 17 Vet.App. 305, 317 (2003) (stating that flawed methodology in creating a medical report renders report of "questionable probative value"); Bielby v. Brown, 7 Vet.App. 260, 269 (1994) (finding that a medical opinion is of no evidentiary value where it fails to consider the correct facts as documented in the veteran's claims file). Here, the inadequate VA medical examination report frustrates judicial review. See Hicks v. Brown, 8 Vet.App. 417, 422 (1995) (concluding that inadequately developed record, due to inadequate medical examination, frustrates judicial review). At a minimum, the Board should have sought clarification with regard to the May 2005 examiner's opinion that the appellant had ulcerative colitis beginning in 1997.

The May 2005 VA examiner's opinion is deficient for another reason. The appellant argues, and the Court agrees, that the Board failed to ensure that the RO had complied with the Board's 1988 remand order. Appellant's Br. at 10-11. In Stegall v. West, 11 Vet.App. 268 (1998), the Court held that "a remand by this Court or the Board confers on the veteran or other claimant, as a matter of law, the right to compliance with the remand orders" and that "a remand by this Court or the Board imposes upon the Secretary . . . a concomitant duty to ensure compliance with the terms of the remand." 11 Vet.App. at 271.

In its remand order, the 1998 Board required the appellant to undergo a gastrointestinal examination. That order instructed the examiner to review the claims file and "identify any current gastrointestinal disorder and indicate whether that disorder had its onset in service and whether the disorder is caused by another service-connected disorder." R. at 1913 (emphasis added). Additionally, the remand order stated that "the examiner should also indicate [the] extent to which colitis, if not caused by another disorder, has been aggravated by that disorder." Id.

Further, the examiner was specifically ordered to comment upon "whether it is at least as likely as not that colitis is attributable to a history of antibiotic treatment for prostatitis or whether the appellant's "colitis has been made worse by antibiotic treatment for prostatitis." Id. The examiner did respond to the question of whether the appellant's colitis was aggravated or caused by his prostatitis. However, as discussed above, this answer was flawed because it was predicated upon an erroneous factual basis. It is clear that the VA examiner did not address the broad question posed by the Board regarding whether either of the appellant's gastrointestinal disorders could have been caused or aggravated by a service-connected disorder other than colitis. In this case, the appellant was service connected for depression. The record contained a private medical opinion that the appellant's colitis occurred more frequently when the appellant was under stress and he submitted a medical article that stated that depression and anxiety could aggravate gastrointestinal disorders.

The Court does not agree with the Secretary that the VA examiner considered the effect, if any, of the appellant's service-connected mental disorder on his gastrointestinal disorders. Secretary's Br. at 6. The VA examiner does not mention, much less discuss, the appellant's mental disorder in his opinion. The Court concludes that the Board failed to ensure compliance with the terms of the October 1998 remand.

II. RATING INCREASE FOR PSYCHIATRIC DISABILITY

In June 1998, the appellant was awarded service connection for an acquired psychiatric disorder and assigned a 50% disability rating. R. at 1828-31. In April 2003, the appellant filed a claim for an increased rating for his psychiatric condition. R. at 2574. In conjunction with his claim, he submitted a March 2003 private psychiatric treatment report that contained a diagnosis of major depression and generalized anxiety disorder and a Global Assessment of Functioning Score (GAF) score of 50.# R. at 2571-72. In February 2005, the appellant underwent a VA mental disorders examination. R. at 26671-76. The examiner diagnosed the appellant with major depression and generalized anxiety disorder and assigned a GAF of 58.# R. at 2671-76.

In June 2005, the RO denied the appellant's claim. R. at 2777-84. He appealed this denial. R. at 3316-17. In the August 1, 2006, Board decision here on appeal, the Board concluded that the appellant's service-connected mental disorder did not satisfy the criteria for a disability rating in excess of 50%. R. at 7-8.

The Board's determination regarding the degree of a claimant's impairment is a question of fact that the Court reviews under the "clearly erroneous standard." Johnston v. Brown, 10 Vet.App. 80 (1997); see 38 U.S.C. § 7261(a)(4); Gilbert, 1 Vet.App. 49 at 53. When reviewing the Board's factfinding, the Court may only "hold unlawful and set aside such finding if the finding is clearly erroneous." 38 U.S.C. § 7261(a)(4); Gilbert, 1 Vet.App. at 52-53. In determining whether a finding is clearly erroneous, "this Court is not permitted to substitute its judgment for that of the Board on issues of material fact; if there is a 'plausible' basis in the record for the factual determinations of the BVA . . . we cannot overturn them." Id. at 53.

The appellant argues that the Board provided inadequate reasons or bases for denying an increased rating for his service-connected psychiatric condition. Specifically, he argues that the Board failed to discuss two medical examinations conducted in 1971 and 1988. See Appellant's Br. at 13. The Court is not persuaded by the appellant's argument. In a rating-increase claim, the present level of disability is the primary focus of the claim. Francisco v. Brown, 7 Vet.App. 55 (1994) (holding that where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern). Therefore, evidence regarding the appellant's psychiatric condition in 1971 or 1988, many years before he filed his claim, could hardly be said to relate to his level of disability at the time of the Board's 2006 decision, see Francisco, supra.

The Board decision specifically explained that the medical evidence of record, particularly the 2003 and 2005 medical examinations, which were conducted contemporaneously with his ratingincrease claim, did not demonstrate that the appellant was entitled to an increased evaluation. In doing so, the Board properly took into account the rating criteria for evaluation of mental disorders, the appellant's symptoms, GAF scores, and the occupational and social impairment resulting from his mental disorders. The Court holds that the Board decision is supported by a plausible basis in the record as a whole. Furthermore, given the level of detail in the Board decision, the Court finds that the decision did include an adequate statement of the reasons or bases for its weighing of the evidence and its conclusion that the appellant is not entitled to disability rating in excess of 50%. See Allday and Gilbert, both supra.

Next, the appellant contends that his claims file "contains medical evidence reflecting decades of severe occupational impairment due to his service-connected psychiatric condition" and that the Board failed to discuss this "undebatable fact." Appellant's Br. at 14. The appellant provides no record citations to support this sweeping argument. The record on appeal in this case is well over 3000 pages. The Court will not comb through hundreds of pages of medical records in an attempt to find support for the appellant's argument. Because it is the appellant's claim, it is his burden to demonstrate error. See Hilkert v. West, 12 Vet.App. 145 (1999). The appellant has not met his burden in this case.

Finally, the appellant argues in Section Six of his brief that the Board failed to consider entitlement to service connection for psychiatric conditions other than major depression. See Appellant's Br. at 15-16. He argues that the Board failed to consider "other diagnoses" and claims that "the medical records reflect other diagnoses with corresponding favorable medical nexus opinions." Id. at 15. Again, the appellant provides no support whatsoever to substantiate this argument. There are no record citations to support his argument, and the appellant does not even identify what the "other" diagnoses are that the Board allegedly failed to consider in its decision. Additionally, he does not state when he filed a claim for these other diagnosed mental illnesses and whether the RO ever adjudicated such a claim. The Court notes that the appellant's argument in this regard does not comply with Rule 28 of the Court's Rules of Practice and Procedure, which requires that in the argument section of a brief, the appellant state "the reasons for [the] contention[ ], with citations to the authorities and part of the record on appeal relied on." As stated above, the Court will not comb through thousands of pages of medical evidence, statements from the appellant, and VA procedural documents in an attempt to discern the appellant's argument and to find support for that argument. The appellant has failed to establish his burden of demonstrating error. Berger v. Brown, 10 Vet.App. 166, 169 (1997) ("[A]ppellant . . . always bears the burden of persuasion on appeals to the Court.").

III. PELVIC PAIN

In April 2003, the appellant filed a claim seeking service connection for pain. R. at 2548-49. In its decision, the Board correctly stated that pain alone without a diagnosed or identifiable underlying malady or condition does not in and of itself constitute a disability for which service connection may be granted. Sanchez-Benitez v. West, 13 Vet.App. 282 (1999). The Board concluded that even though the veteran has complaints of pelvic pain, "there is no medical or competent evidence of a diagnosis of an underlying disability manifested by pain" other than from his already service-connected prostatitis. R. at 23. The Board concluded that to the extent that the appellant suffers from pain associated with his prostatitis, it would be considered in rating his prostatitis. The Court agrees with the Board that here is no legal basis to authorize service connection for pain. Moreover, the Court notes that appellant has not challenged the disability rating assigned for the appellant's prostatitis. Accordingly, the Court concludes that the appellant's claim for service connection for pelvic pain is without merit.

IV. CUE CLAIMS

On April 4, 2006, the Court vacated and remanded that part of a December 1, 2003, Board decision that determined that the March 1977, April 1985, September 1986, and May 1989 Board decisions did not contain clear and unmistakable error (CUE). Rife v. Nicholson, No. 04-11, 2006 WL 116778 (Vet. App. Apr. 6, 2006). The Court concluded that the Board provided an inadequate statement of reasons or bases for its December 2003 decision determining that there was no CUE in those Board decisions. Rife, 2006 WL 116778, at * 7-8.

The appellant contends that the Board failed to adjudicate the CUE claims that were remanded by the Court See Appellant's Br. at 5-7. His claim is without merit. Because there is no final Board decision on the CUE claims that were remanded by the Court, the Court is without jurisdiction to address this matter on the merits. See 38 U.S.C. §§ 7252(a) (noting that the Court has exclusive jurisdiction to review final Board decisions); 38 U.S.C. § 7266(a) (Court reviews final Board decisions); Matthews v. Principi, 15 Vet.App. 138 (2001) (per curiam order) (dismissing appeal for lack of jurisdiction because there is no final Board decision when claim is remanded to VA regional office (RO) for further development).

Relying on Deshotel v. Nicholson, 457 F.3d 1258, 1261 (Fed. Cir. 2006), the appellant argues that the Court should deem that the CUE claims were denied by the August 1, 2006, Board decision, and that the Court should vacate the Board decision and order the Board to address his claims. The appellant's argument is unavailing. In Deshotel, the Federal Circuit held that a claim is "deemed denied" by the RO when a claimant files more than one claim at the same time and the RO explicitly denies one of the claims but fails to specifically address the other claim. Deshotel, supra. The holding in Deshotel is limited to RO adjudications and it is clear that the decision does not apply to decisions by the Board. When a final Board decision is issued, the appellant is free to appeal that decision to the Court. See 38 U.S.C. #SYMBOL \f "Symbol"95 7266 [sic]. If the appellant feels that there is an unreasonable delay in the adjudication of his CUE claims, he may file a petition for extraordinary relief in the nature of a writ of mandamus. See 28 U.S.C. #SYMBOL \f "Symbol"95 1651 [sic]; DiCarlo v. Nicholson, 20 Vet.App. 52, 56-57 (2006) ("If the Secretary fails to process the claim, then the claimant can file a petition with this Court challenging the Secretary's refusal to act.").

V. UNREIMBURSED MEDICAL EXPENSES

The appellant's final argument is that the Board failed to address his entitlement to medical expense reimbursement. Specifically, the appellant contends that "[t]he Board previously remanded [his] claim for medical reimbursement of a penile implant removal and replacement in 2003 . . . [but] [t]he Board's most recent decision did not address the issue." Id. at 17-18. As noted previously, this Court's jurisdiction is limited to review of final Board decisions. See 38 U.S.C. §§ 7252 and 7266. A BVA remand is not a final decision within the meaning of 38 U.S.C. § 7252(a). See Kirkpatrick v. Nicholson, 417 F.3d 1361 (Fed. Cir. 2005). Because the Board has not issued a final decision with respect to the appellant's claim for unreimbursed medical expenses, the Court does not have jurisdiction to review that issue. See Hampton v. Gober, 10 Vet.App. 481, 483 (1997).

VI. CONCLUSION

Upon consideration of the record and the pleadings of the parties, the Court AFFIRMS that part of the August 1, 2006, Board decision that denied service connection for PTSD and pelvic pain, and denied claims for increased disability ratings for service-connected major depression, scarring of the penis, and prostatitis claim.

The Court VACATES and REMANDS that part of the Board decision that denied the appellant's claim for service connection for gastrointestinal disorders.

DATED: August 29, 2008

Copies to:

Darla J. Lilley, Esq.

VA General Counsel (027)

[carlie]

Lady T,

My brother has Chrone's disease, a bit different.

If you want me to ask him any questions on that I will.

I have no other experience with anything like your current illness.

Sorry you have it.

carlie